Strategies to enhance remote monitoring adherence among patients with cardiovascular implantable electronic devices

Thomas L Rotering; Sylvia J Hysong; Katherine E Williams; Merritt H Raitt; Mary A Whooley; Sanket S Dhruva

doi:10.1016/j.hroo.2023.11.002

Strategies to enhance remote monitoring adherence among patients with cardiovascular implantable electronic devices

Heart Rhythm O2. 2023 Nov 8;4(12):794-804. doi: 10.1016/j.hroo.2023.11.002. eCollection 2023 Dec.

Authors

Thomas L Rotering^{1

2

3}, Sylvia J Hysong^{4

5}, Katherine E Williams^{1

6}, Merritt H Raitt^{7

8}, Mary A Whooley^{1

3

9}, Sanket S Dhruva^{1

2

3}

Affiliations

¹ San Francisco Veterans Affairs Health Care System, San Francisco, California.
² Section of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California.
³ Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California.
⁴ Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
⁵ Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
⁶ Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California.
⁷ Portland Veterans Affairs Health Care System, Portland, Oregon.
⁸ Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon.
⁹ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California.

Abstract

Background: Remote monitoring (RM) of patients with cardiovascular implantable electronic devices (CIEDs) (pacemakers and implantable cardioverter-defibrillators) has a Class 1, Level of Evidence A Heart Rhythm Society recommendation. Yet RM adherence varies widely across settings, and factors associated with variation are not understood.

Objective: The purpose of this study was to identify strategies for supporting RM across Veterans Health Administration (VHA) facilities.

Methods: In a national evaluation, we surveyed and interviewed 27 nurses, medical instrument technicians, and advanced practice providers across 26 VHA facilities (following approximately 15,000 CIED patients). Participants were selected based on overall patient adherence by facility, which ranged from 46%-96%. Questions covered RM adherence strategies, manufacturer resources, organizational characteristics, and workflows for optimizing adherence.

Results: All clinicians reported that RM adherence was extremely important (53.8%), very important (34.6%), or important (11.5%) for improving patient outcomes. High performing facilities prioritized consistent patient education about RM and evaluated nonadherence using dashboards and manufacturer web sites. High performing facilities instituted clear standard operating procedures that defined staff responsibilities and facilitated efficient contact with nonadherent patients and then family members by phone and then mail. Clinicians based at high performing facilities spent twice as many hours per week (9.1) on average managing RM adherence compared to other facilities (4.5). Effective communication (internally and with non-VHA care partners) and use of CIED manufacturer resources were essential. Facilities that were not high performing rarely used these strategies.

Conclusion: Clinicians can support high RM adherence by emphasizing patient education, regularly assessing and addressing nonadherence using staff protocols, and engaging CIED manufacturers.

Keywords: Cardiovascular implantable electronic device; Implantable cardioverter-defibrillator; Pacemaker; Patient adherence; Remote monitoring.

Abstract

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